Mass dismissals, Chile’s payment to the health workers who saved their lives. It goes without saying that the last few years have been very difficult for the public health system in our country. In addition to the overload experienced during the time of the pandemic, there has been a major crisis in the private sector related to this ambit. Not even the economic development that has taken place in Chile has resolved the profound inequalities that affect the legitimate right to health of the Chilean population.
Ten years after the implementation of the last reform of the system began, this continues to be a priority ambit in the preoccupation of the population and part of the current demands of citizens. The central principle that guides Chilean health policy, and justifies the treatment it receives, is the paradigm of targeting, which implies that public policies are designed for specific groups of the population that are in a “situation of deprivation” and therefore require state assistance; an approach that ends up destroying the concept of universality in social rights, generating a serious problem of exclusion.
This has gone hand in hand with a series of administrative practices that have damaged the economic management of the public sector, making it increasingly incapable of meeting the health demands of the population, which demands greater access. This shortcoming has been used as an argument to claim that public health is inefficient and to justify the transfer of millions in resources to the private sector. This year, the health budget is more than 12 billion pesos, implying a negative variation of -0.4%, which represents a total growth of 7.1% compared to the previous year, and which at the no end of the scale translates into a per capita in Primary Health Care (PHC) of 10,000 pesos per user.
Today, once again, the public health system is in crisis, because the fundamental personnel for its functioning and the provision of care to the Chilean population is in conflict with the authorities. Various federations of health workers staged a 48-hour strike in answer to the dismissal of more than 6,000 professionals and technicians in the field, dismissals that are taking place in the context of the end of the covid19 health alert in our country. The pandemic allowed the government to hire professionals under the figure of fee-based contracts, who were dismissed or not renewed at the end of it, generating the annoyance of the unions and that, not receiving solutions from the Ministry of Health, the Board of Confusam will define in the coming days the possibility of a new stoppage.
The Medical Association did not join the strike, but has shown solidarity with the mobilisation pushed by non-medical health workers’ organisations. Patricio Meza, president of the doctors’ union, told the press: “We want them to be honest about what the health objectives of our country are. If we want to achieve the health goals, we need these officials to continue their work…” “We call on the government to make an extra effort, if we want to meet the health needs, we require 100 per cent of the civil servants…” “The waiting lists are a real health emergency… “If the government says their priority is public health, they should take charge of what they are saying.”
The Ministry of Health made concrete the dismissal, via the termination of contracts, of the 6,300 civil servants, citing the end of the Covid-19 health alert. Their public statement says that “These conditions will allow us to say that there are 9.7 civil servants per thousand inhabitants. This is better than in 2019, pre-pandemic, when there were 7.5 per 1,000 inhabitants,” said the health authority.
The collapse of the health system has been warned for some time by the main actors, and is being suffered by the salaried, unemployed and retired population who are its users. The budgetary justifications put forward by the authorities are called into question if we consider that, at the same time, they finance the unjustifiably high expenses of the Armed Forces, whose personnel, in a country that has no military conflicts, are far less necessary and less of a priority than the technicians and professionals of public health, in a country where citizens die stagnating on eternal waiting lists for lack of specialised care.
This is what is popularly known as “Chile’s payment”. Our heroines and heroes, who dramatically confronted the emergencies of the population in a pandemic, are today “disposable”. Thousands are thrown into unemployment, at a time when sustaining a food basket and fixed housing costs plus monthly mobilisation is increasingly a difficult family goal.
The lack of prioritisation of health as a central axis of governance leaves us always hearing these economistic justifications. And not everything has to do with money. There is a silenced clamour that anyone who wants to listen will hear clearly: the health system can no longer withstand the change of authorities; with each new government, people come in to lead without competence or expertise, the so-called political positions, which in practice become an overload of work for the professionals and middle managers in hospitals, specialised centres, etc. of the permanent staff of the system. Dealing with incapable managers, who have to be taught how to work from scratch and, when over time they become clearer in their roles, a new election produces a new change… and it starts all over again, in a circle of insufferable repetition.
This is affecting medical answers in the regions of the country, with the paradox that infrastructure efforts in these places are limited due to a lack of specialised personnel, and today, in this scenario, the status of these hospitals is being downgraded, forcing their users to travel again to centres in metropolitan areas in search of care. And, at the same time, for those staff who have been attacked by mass redundancies, hopelessness and tedium cloud their daily work and close off their future. Ultimately, the “political charges” are undermining the possibility of a national public health project. The reasonable answer is that these directorates should not respond to party quotas, and should be highly professionalised, decentralised, with systems of control and probity.
When a health inequality is avoidable and unjust, that is, if in the chain of events that caused the loss of a human life, there was a lack of resources or attention from the public sector, or some other social determinant (environmental pollution, poverty, poor housing conditions, poor nutrition), then we are facing a flagrant and intolerable inequity, a failed system, which must be radically overcome.
Above all, the health of our people, and this does not allow for justifications or delays.
Collaborators: M. Angelica Alvear Montecinos; Guillermo Garcés Parada; Sandra Arriola Oporto; Ricardo Lisboa Henríquez and César Anguita Sanhueza. Public Opinion Commission
